Home Health Checklist


Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.

Proficiency Scale:

1 = No Experience

2 = Need Training

3 = Able to perform with supervision

4 = Able to perform independently

  CARDIOVASCULAR         Rating Stars (Click) 1 2 3 4
  ACS/Post MI�  
  Heart Failure�  
  Post Cardiac Surgery  
  Cardiac Auscultation (Rate/Rhythm)�  
  Peripheral Pulse/Circulation Checks  
  PULMONARY         Rating Stars (Click) 1 2 3 4
  Asthma  
  COPD  
  Pneumonia  
  Lung Cancer  
  Pulmonary Emboli  
  Auscultate Lung Sounds  
  Oxygen Administration�  
  Oxygen Safety�  
  Oro/Nasotracheal Suctioning�  
  CPAP/BiPAP�  
  Ventilator Management (Specify):  
  NEUROLOGICAL         Rating Stars (Click) 1 2 3 4
  CVA�  
  Alzheimer\'s Disease/Dementia  
  Parkinson\'s  
  Degenerative Neurologic Disorders (ALS  
  MS  
  etc.)  
  Brain Tumor  
  Brain Injury  
  Para/Quadriplegia  
  Seizure Disorder  
  Level of Consciousness/Neuro Changes  
  ORTHOPEDICS         Rating Stars (Click) 1 2 3 4
  Joint Replacement  
  DVT Prophylaxis/Recognition  
  Incision Checks  
  Staple Removal  
  Fractures  
  Cast/Brace  
  Amputation  
  Arthritis  
  Assistive Equipment/Lift Devices  
  In Home PT/INR (Specify):  
  GASTROINTESTINAL         Rating Stars (Click) 1 2 3 4
  Nutritional Assessment�  
  Colostomy/Ileostomy Management  
  Fecal Incontinence/Diarrhea  
  Bowel Obstruction  
  GI Bleed  
  Post GI Surgery  
  Hepatitis Liver Failure  
  NG Tubes  
  Feeding Tubes  
  Feeding Pumps (Specify):  
  Drainage Devices  
  RENAL/GENITOURINARY         Rating Stars (Click) 1 2 3 4
  Hemodialysis  
  AV Fistula/Shunt  
  Peritoneal Dialysis  
  Post Bladder Surgery  
  Post Prostate Surgery  
  Urostomy  
  Urinary Incontinence  
  Bladder Catheter Insertion/Maintenance  
  Suprapubic Catheter Insertion/Maintenance  
  ENDOCRINE/METABOLIC         Rating Stars (Click) 1 2 3 4
  Diabetes  
  Hyper/Hypoglycemia  
  Diabetic Skin Assessment  
  Cushing\'s / Addison\'s Disease  
  Thyroid Disease  
  Insulin Pumps  
  Glucometers  
  WOUND/SKIN CARE         Rating Stars (Click) 1 2 3 4
  Braden Scale  
  Pressure Ulcer Prevention  
  Pressure Ulcer Staging  
  Pressure Ulcer Management  
  Burns  
  Wound Care  
  Wound Cultures  
  Wound Vac  
  ONCOLOGY         Rating Stars (Click) 1 2 3 4
  Risk for Infection  
  Symptom Management  
  Side Effects of Treatment  
  Terminal Disease  
  INFECTIOUS DISEASE         Rating Stars (Click) 1 2 3 4
  MRSA  
  VRE  
  C. Difficile  
  HIV  
  Tuberculosis  
  Isolation Precautions  
  PHLEBOTOMY/IV THERAPY         Rating Stars (Click) 1 2 3 4
  Peripheral Venipuncture for Labs  
  Start Ivs  
  Peripheral Ivs  
  PICC/CVP Lines  
  Venous Access Ports  
  Infusion Pump Set up and Management  
  Specify Infusion Pump Type:  
  PSYCHIATRIC         Rating Stars (Click) 1 2 3 4
  Cognitive Disorders  
  Mood Disorders  
  Schizophrenia/Psychotic Disorders  
  Medication Compliance  
  WOMENS HEALTH/MATERNAL-INFANT CARE         Rating Stars (Click) 1 2 3 4
  Pregnancy Related Complications  
  Fetal Heart Tones  
  Contractions  
  Post Partum Mother/Baby Visit  
  Newborn Care  
  Phototherapy�  
  Breast Feeding Support  
  PEDIATRICS         Rating Stars (Click) 1 2 3 4
  Growth and Development  
  Respiratory Distress Syndrome  
  Bronchopulmonary Dysplasia  
  Cystic Fibrosis  
  Muscular Dystrophy  
  Spina Bifida  
  Spinal Surgery  
  Sickle Cell Disease  
  Trach Care/Suctioning  
  Ventilator Management  
  Ventilator Type (Specify):  
  PAIN MANAGEMENT         Rating Stars (Click) 1 2 3 4
  Verbal/Nonverbal Pain Scales  
  Response to Pain Management Interventions�  
  PCA Pump�  
  Epidural Cath/Site Monitoring/Pump�  
  Non-Pharmacologic Pain Measures  
  PALLIATIVE AND END OF LIFE CARE         Rating Stars (Click) 1 2 3 4
  Palliative Symptom Management�  
  Pain Management/Response  
  Family Support/Teaching  
  After Death Protocols  
  MEDICATIONS         Rating Stars (Click) 1 2 3 4
  Alzheimer\'s Medications  
  Antiarrhythmics  
  Antibiotics/Antivirals  
  Anti-Depressants  
  Anti-Hypertensives  
  Anti-Psychotics  
  Anti-Seizure Medications  
  Benzodiazepines  
  Calculation of Pediatric Dosages  
  Coumadin  
  Diuretics  
  Enoxaparin�  
  Inhaled Medications  
  Nebulizer Medications  
  Insulin  
  Opioid and Non-Opioid Analgesics  
  Oral Chemotherapy  
  Oral Hypoglycemics  
  Oral & Topics Nitrates  
  Rivaroxaban  
  Sedative/Hypnotics  
  Steroids  
  HOME HEALTH         Rating Stars (Click) 1 2 3 4
  Intake/Admissions  
  Case Manager  
  Case Load - Pts/Day(specify)  
  Supervise LVNs/HHAs�  
  Medicare/Medicaid  
  Long/Short Term Disability  
  Private Insurance  
  Telephonic Assessments  
  Management of Complaints  
  APS Reports  
  OASIS  
  Diagnosis Coding  
  Document Plan of Care  
  Clinical Assessment Documentation  
  PROFESSIONAL KNOWLEDGE AND SKILLS         Rating Stars (Click) 1 2 3 4
  National Patient Safety Goals/Core Measures  
  Safety Assessment  
  Fall Assessment and Prevention  
  Patient/Family Teaching  
  Age Specific/Population Based Care  
  EMR         Rating Stars (Click) 1 2 3 4
  Allscripts  
  Cerner�  
  Epic  
  HomeCare Home Base  
  McKesson  
  Meditech  
  Other Computerized Documentation System  
  EMR Conversion  
  Age Specific Competencies         Rating Stars (Click) 1 2 3 4
  Infant (Birth - 1 year)  
  Preschooler (ages 2-5 years)  
  Childhood (ages 6-12 years)  
  Adolescents (ages 13-21 years)  
  Young Adults (ages 22-39 years)  
  Adults (ages 40-64 years)  
  Older Adults (ages 65-79 years)  
  Elderly (ages 80+ years)